From the Guidelines
Patients with dysphagia to solid foods should undergo a comprehensive swallowing evaluation by a speech-language pathologist and receive individualized treatment, including dietary modifications, swallowing therapy exercises, and compensatory techniques, to improve swallowing safety and reduce the risk of complications, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment approach for dysphagia to solid foods should be multifaceted and tailored to the underlying cause. This may include:
- Modifying the diet to include softer, moist foods and thickened liquids
- Performing swallowing therapy exercises to strengthen muscles and improve coordination
- Using compensatory techniques, such as posture modification and sensory input, to optimize the efficiency and safety of the swallow
- Maintaining proper oral hygiene and staying well-hydrated to prevent complications
Swallowing Evaluation
A comprehensive swallowing evaluation should be performed by a speech-language pathologist to assess the patient's swallowing function and identify any impairments or risks. This evaluation may include:
- Bedside swallowing assessment
- Videofluoroscopic swallow study (VSS) or fiberoptic endoscopic examination of swallowing (FEES)
- Assessment of dietary needs and specialized nutrition plans
Compensatory Techniques
Compensatory techniques may be used to optimize the efficiency and safety of the swallow, including:
- Posture modification
- Sensory input with bolus
- Volitional control
- Texture modification
- A rigorous program of oral hygiene
Education and Support
Patients, families, and caregivers should receive education on swallowing and feeding recommendations, including:
- How to modify the diet and use compensatory techniques
- How to perform swallowing therapy exercises
- How to maintain proper oral hygiene and stay well-hydrated
- How to reduce the risk of complications, such as aspiration pneumonia
Recent Evidence
The most recent and highest quality study 1 recommends systematic and sufficiently frequent swallowing therapy, making individualized use of the different exercises available, in patients suffering from oropharyngeal dysphagia. This study provides strong evidence for the effectiveness of swallowing therapy in improving swallowing function and reducing the risk of complications.
From the Research
Treatment Recommendations for Dysphagia with Solid Food
- Dietary adjustments are a crucial part of therapy for dysphagia, ensuring the patient is nourished safely while being taught therapeutic and compensatory strategies for dealing with the swallowing disorder 2.
- The consistency of solid foods may be adjusted to ensure an adequate diet that is safe for the patient, and liquids may be thickened to reduce the risk of aspiration 2, 3.
- A four-level diet plan can be proposed for patients who have difficulty swallowing solids and liquids, gradually advancing for patients undergoing treatment to improve swallowing function 3.
- For patients with dysphagia who are unable to eat safely or take adequate amounts of food orally, an alternative feeding method should be instituted, such as enteral feeding 2, 4.
- When administering medications to patients with dysphagia, clinical judgment is needed to identify medications that can and cannot be crushed, select a crushing methodology and vehicle, and create a strategy for administering multiple medications 5.
Strategies for Managing Dysphagia
- Kitchen and nursing staff must be trained to remove solid foods and liquids that pose swallowing hazards from standard diet trays, and to prepare texture-modified foods that are safe for dysphagic patients 3.
- The use of elastic components and their effects on the cohesiveness of the bolus should be taken into account when preparing texture-modified foods, in addition to viscosity increase 6.
- A coordinated effort from the entire care team, including physicians, pharmacists, nurses, and speech therapists, is necessary to develop and implement an individualized plan for managing dysphagia and administering medications 5.
- Reinstituting oral feeding in tube-fed adult patients with dysphagia requires an appropriate strategy, including intensive dysphagia therapy and gradual advancement of diets 4.